- MOULIAS R , ALMA (allo mistreatment), professor emeritus university Paris VI

1. ACTIONS TO COUNTER ELDER ABUSE IN FRANCE seventeen years of experience - MOULIAS R , ALMA (allo mistreatment), professor emeritus university Paris VI - BUSBY F, ALMA (allo mistreatment)

2. To act is more useful than to become indignant • At the last quart of the XXst century, spreading out of awareness on Elder Abuse. • Obvious need to go further than describing facts • But how to break the taboo ? • How to know and to « treat » Elder Abuses ? • How to organize an efficient prevention ? • How to create skilled teams able to understand and to resolve complex abuse situations ? • How to create knowledge in this « new » field ?

3. Birth of Allo maltraitance (ALMA)a helpline devoted to Elder Abuse • 1994 : a geriatrician : Pr Hugonot, created the first local helplines in five french districts • Helpline must be : - in the neibourghood of the victim - competent in the field - warranting confidentiality to callers and ethical rules for the victim -respect autonomy of the victim (choices) • 2008 : national N°39 77 for calls for Elder Abuse, analyse, counsel and follow up remains made by ALMA

4. Proximity helplines for listening and counsel : ALMA (allo maltraitance) • 1 ) Voluntary basis • 2 ) Competence : Specific education and training of the entire team, pluridisciplinatity, voluntary professionals • 3 ) Independence of any power, absence of conflict of interests • 4 ) Neutrality • 5 ) Proximity (knowledge of local actors and networks) • 6 ) Confidentiality warranted, and ethical rules of running • 7 ) Preservation of autonomy of caller and victim. • 8 ) Evaluation of outcomes

5. To prevent is better than to treat : education and training • ALMA (associative): first : sensitizations targetted to nursing homes staffs, home care services, today: + targetted also towards management, judiciary guardians, social workers, police, professional education (medicine, nurses, psychologists, barristers, etc) • SF G Gerontology : Tools to avoid E A (Mobiqual) • STATE : - Medico -social Agency ANESM : Good Practices recommendations - Instructions to Regional Health Agencies - Funding helplines: ALMA network and national N°3977

6. Birth of the concept of « good caring » (bientraitance) • Perfection in technical help and care is not sufficient i long term care : • Is the staff aware of needs, wishes, values of the person • Is the team trained to give priority to objectives of the well-being and the dignity of the person? • to permit to live with well being and dignity in spite of a « dependent «  situation = aim of « well caring » • A very valorizing concept for teams of L T C

7. France counts 100 ‘départements’ ALMA France covers 75% of the territory 1995 2012 ALMA centres Dossiers monitored by ALMA

8. ALMA France goals Pledge for ABUSE PREVENTION MEANS Furtherexpand network Support and strengthen ALMA centres Developstudies and research Extendpartnerships(national and international) Inform and train about abuse TRAINING ALMA volunteers PROFESSIONALS : medical, social workers, managers, lawiers, psychologists, etc Aged public and familial caregivers Politicians, etc.

9. Management of each ALMA centre LOCAL ADVISORY COMMITEE (medical, social, judicial local authorities) - contacted punctually by the counsellors -Takes measures to «treat» the abuse situations -informs ALMA about measures taken -once a year, meet the ALMA team ADMINISTRATORS -founding centres, searching for financial support, technical facilities Recruiting volunteers, organizing traning sessions for them -tightening bonds with advisory committee, other centres and ALMA France -Warranting ALMA ethical rules Coordinator (part-time salary) LISTENERS COUNSELLORS

10. Profile of the volunteers (retired, active or students) listeners Mr. or Mrs EVERYBODY ready to learn to listen! Persons who were faced with abuse Professionals from various backgrounds Students Always : specific selection, education, and training: must be skilled counsellors Social workers Medical and health professionals (GP, psychiatrists, geriatricians, nurses, managers) Justice staff Psychologists Social workers etc.

11. Learn about abuse and risks abuse Repeatedly ? Financial abuse Psychological abuse Physical, sexual abuse Refreining of citizen rights Medical abuse Neglect Undue influence Risks ( for whom ?) At home and in the city In institution Health problems Dependency on others Financial difficulties Lack of time of pro Reduced, untrained team Burn out NH dysfunction, etc.

12. The HEART of an ALMA centre : listeners Listeners (2) -listen with a systemic approach : draw sociogram while listening -search for information -take notes, fills in dossiers -transmits to counsellors -take part in analysis -respect ALMA ethical rules Good practices for listening

13. For listeners and counsellors : sociograman unique ALMA tool G.P. home helper l neighbour ?? CALLER ? ‘AUTHOR’ ? ? ? :: A sociogram is a graphic representation which serves to reveal, visualize the relationships between ‘victims and agressor’, within the family and their external environment such as health and social services, work, friends, neighbours, etc.

14. clarification of situations LISTENERS listen and search for information Whoisinvolved ?  Whatis the healthstatus of all personsinvolved ?  Where ? at home, in institution ?  Whoknows about the situation ?  What are the problems, the complaints ?  Are theyrepeated ?  Sincewhen ?  Are thereotherwitnesses ?  Do the victimsget social or medical help ?  What are the caller’s questions ?  Whatisexpectedfrom ALMA ? CALLERS Professionals Family members friends, neighbours ‘Victims’ rarely 

15. COUNSELLORS ALERT COUNSEL - GUIDE TIGHTEN BONDS with medical, social and judicial services ENCOURAGE mediation CALLERS Professionals Family members friends, neighbours ‘victims’rarely 

16. The HEART of an ALMA centre : counsellors • Multi-disciplinary counsellors • inform, guide, counsel callers • follow through, monitor dossiers from first call to ‘solution’ • Encourage the callers and witnesses to take measures • support the professionals in coordinating helping measures •  refer to the advisory committee when necessary • -- Only one aim : end of mistreatment • With respect to strict ethical rules • - Good practices for counselling

17. Is the complaint relevant ? 3 calls : this 70 yearold man ismistreated, neglected, abandoned ! Do something !! ALMA calls the mayor of the town ! This man iswellknown and HAPPY ! in HIS way!! ?Not according to the life values of the callers !!

18. ALMA ETHICAL RULES DOUBLE LISTENING  MULTI-DISCIPLINARY ANALYSIS AND COUNSELLING  CONFIDENTIALITY, DISCRETION  NO JUDGEMENT, IMPARTIALITY  ACT WITH AGREEMENT OF CALLERS/VICTIMS  FOLLOW UP WITHIN THE LEGAL TEXTS (danger to victim ?)  RESPECT THE DIGNITY OF ALL PERSONS INVOLVED 18

19. OUTCOMES • 62 ALMA Centres cover 75 % of the french territory • « Treat » and follow up 5.000 situations of mistreatment each year (80 % in home and city, 20 % in NH). • Sensitize and train 15.000 to 20.000 professionals/ year • Start studies and publications in the different fields of Elder Abuse (Neglect, Inappropriate care, Undue influence, Financial abuses, Neglect in terminal care, Reglementary abuses, Cohabitation, Good Practices in listening and counselling, Methodology for helplines for E A, Well -caring, etc)

20. Conclusion • Associative helplines working in a national network gives an efficient way to « treat » E A situations and to strongly reduce abuse and neglect in Nursing Homes and Home Care services but also iin family and in the city • Conditions of competence, proximity, independence and respect of ethical rules can be more warranted by associative organizations • Voluntary work gives independence, large panels of competence and a low cost for this new type of helplines.

21. Conclusion (2) • Sensitization and training of all involved teams on prevention and well-caring is the necessary other activity of such helplines and requires also Good practices and ethics of training. • The field is not limited to medico social areas of care homes and home care • Trainers must be trained expert professionals • ALMA system can be adapted in any other country

22. Thank you for your attention and your questions contact@alma-france.org